Provider First Line Business Practice Location Address:
2811 8TH ST S
Provider Second Line Business Practice Location Address:
SUITE 50
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494-6281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-423-3020
Provider Business Practice Location Address Fax Number:
715-423-3012
Provider Enumeration Date:
10/16/2007